Public and Private Sector (Personal Reflections 3)

An end of the year tongue-in-cheek answer to the spin-off question: why do more specialists look happier in the Singapore private sector? Personally, I think there could be several reasons.

Firstly, part of it could just be perceptual in nature: they look happier because appearing happy pays off better than looking pessimistic and frustrated. A perpetually black-faced doctor will likely have fewer referrals from colleagues and patients. I have known of colleagues and seniors who appear to have had “personality transplants” after exiting the public sector.

There is comparatively far less bureaucracy and paperwork in the private sector. Once one gets past the initial administrative hurdle of setting up one’s clinic (which involves significant paperwork and bureaucracy!), there are few complicated rules or constraining protocols to follow. One does not need to be part of any committee one does not wish to be part of, and (as examples) JCI is someone else’s problem; there is no “antibiotic police”.

There is now singularity of purpose work-wise. The bottomline is the only KPI that matters, and plying one’s skills to achieve better clinical outcomes for the patients is the major determinant to meeting this KPI. Unsurprisingly this is very satisfying for most doctors – after all, it is what we train for. There is none of that “how many papers did you publish”, “how did the students rate you”, “how many committees were you part of”, “what clinical carepath did you institute”, “are you locally/regionally renowned” type of KPI that confounds many specialists in the public sector who try to meet them while vying for a relatively trivial variable amount of bonus. Note that these ancillary activities (research, teaching, setting of clinical standards and guidelines, etc.) do enable many doctors to feel more fulfilled at work in the public sector, and many private specialists I know have at times complained about being bored. The trade-offs are apparent, but not sufficient to cause an exodus back to the public sector, even for those where the tedium level is very high.

Unfortunately, this very plurality of KPIs has the potential to create “class-like” mindsets. This is in some ways inevitable, although the public sector hospital administration has tried very hard to limit such thinking. There appears to be a nagging feeling among several specialists that do not do research in academic medical centres that they are a little less valued, despite having to shoulder more of the clinical workload. In some departments, trainees might feel the pressure to do research in order to better secure their future jobs. Conversely, a colleague recently mentioned facing a kind of “reverse pressure/snobbery” not to do research in a regional hospital. These little perceptions of inequality, real or otherwise, add tension to jobs that are already not particularly stress-free.

Lastly, most private specialists tend to have more free time relative to their public sector lives. True, there are several who have busy clinics Mon-Sat and are summoned back to the hospital wards at all hours (and are therefore making big bucks in “compensation”); virtually all private specialists respond faster to their handphones than their families; and virtually all have to do far more weekend rounds and come in during public holidays/nights than their counterparts in the public sector. But the usual workday tends to be far less intense for most, and there is relatively greater freedom to do non-work-related stuff (like pick up kids from school or go out for long lunches) – small but not insignificant luxuries of time that is less available to those in the public sector, at least, not if one cared deeply about one’s bonus quantum.